Abstract

Destructive pulmonary inflammation can leave patients with only a single functional
lung, resulting in anatomical and physiological changes that may interfere with subsequent
cardiac surgeries. Such patients are vulnerable to perioperative cardiopulmonary complications.
Herein, we report the first case, to our knowledge, of an autopneumonectomized patient
who successfully underwent a modified Cox-Maze III procedure combined with valvular
repairs. The three major findings in this case can be summarized as follows: (1) a
median sternotomy with peripheral cannulations, such as femoral cannulations, can
provide an optimal exposure and prevent the obstruction of vision that may occur as
a result of multiple cannulations through a median sternotomy; (2) a modified septal
incision combined with biatrial incisions facilitate adequate exposure of the mitral
valve; and (3) the aggressive use of intraoperative ultrafiltration may be helpful
for the perioperative managements as decreasing pulmonary water contents, thereby
avoiding the pulmonary edema associated with secretion of inflammatory cytokines during
a cardiopulmonary bypass. We also provide several suggestions for achieving similar
satisfactory surgical outcomes in patients with a comparable condition.